玻璃体切除术前玻璃体内注射雷珠单抗治疗增生性糖尿病视网膜病变  

The clinical study of intravitreal Ranibizumab injection before vitrectomy for proliferative diabetic retinopathy

作　　者：张凌[1] 陈彬[1] 韩宇[1] 徐智科 陈晓希[1] 

机构地区：[1]乐山市人民医院眼科,四川614000

出　　处：《中华眼外伤职业眼病杂志》2016年第11期846-850,共5页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的：探讨增生性糖尿病视网膜病变（ PDR）在25 G＋玻璃体切除术（以下简称玻切术）之前雷珠单抗（ Ranibizumab）玻璃体内注射对手术的优化作用及其临床效果。方法前瞻性对照研究。我院73例（74眼）PDR,其中A组33例（34眼）,术前给予雷珠单抗0.05ml玻璃体内注射后,于5-7d内行玻切术；B组40例（40眼）,直接行玻切术。比较两组手术所用时间、术中出血情况、使用眼内电凝次数、医源性视网膜裂孔、眼内填充物使用以及术后视力、再次发生眼内出血等并发症情况。结果 A组平均手术时间为（92.0±19.5） min,9眼（26.5%）发生术中出血,共使用眼内透热电凝16次,4眼（11.8%）发生医源性视网膜裂孔,14眼（41.2%）术后行硅油填充,4眼（11.8%）行C3 F8填充,余16眼（47.1%）行平衡盐液填充,术后1个月内无再次眼内出血发生。 B组平均手术时间为（121.0±26.3）min,较A组时间长,差异有统计学意义（t=6.837, P=0.041）；24眼（60.0%）发生术中出血,较A组者多,差异有统计学意义（χ2=8.362, P=0.005）；共使用眼内透热电凝47次,较A组的次数多,差异有统计学意义（t=2.216, P=0.032）；7眼（17.5%）发生医源性视网膜裂孔,与A组比较差异无统计学意义（χ2=0.478, P=0.533）；术后行硅油填充27眼（67.5%）,C3F8填充4眼（10.0%）,平衡盐液填充9眼（22.5%）,与A组比较差异无统计学意义（χ2=5.632,P=0.060）；术后1个月A组视力优于B组,差异有统计学意义（χ2=8.527, P=0.014）,而术后3d及2周两组视力差异无统计学意义；B组术后1个月内4眼再次发生玻璃体内积血,与 A组比较差异无统计学意义（Fisher精确检验P=0.120）。两组均未发生与注射及药物相关的局部及全身不良反应。结论PDR行玻切术前雷珠单抗玻璃体内注射可有效减少术中出血,优化手术操作,同时对术后1个月视力的改善有较好的作用。Objective To investigate the therapeutic effect of 25 G ＋ vitrectomy assisted with preoperative intravitreal injection of Ranibizumab for the treatment of proliferative diabetic retinopathy. Methods A prospective controled analysis in 74 eyes of 73 cases with proliferative diabetic retinopathy treated by vitrectomy from May 2013 to January 2015 was performed. Thirty -four eyes of 33 cases with proliferative diabetic retinopathy received intravitreal injection of Ranibizumab 0. 05ml（ contain ranibizumab 0. 5mg）at 5 to 7 days before the vitrectomy in group A. Forty eyes of 40 cases with proliferative diabetic retinopathy were treated by vitrectomy only as non-injection group （ group B ） . The operative time, hemorrhage during the operation, times of endodiathermy, incidence of iatrogenic retinal tear, kinds of intraocular filling materials, postoperative visual acuity and complications between the two groups were compared. Results The average operation time in group A was （92. 0 ± 19. 5）min less than （121 ± 26. 3） min in group B ,the difference was statistically significant （t=6. 837, P=0. 041） . Hemorrhage during the 〈br〉 operation were observed in 9 eyes in group A （26. 5%）,and 24 eyes（60. 0%） in group B（χ2 =8. 362, P=0. 005） . Endodiathermy was used 16 times in group A,and 47 times in group B（t=2. 216, P=0. 032）. The iatrogenic retinal tear occurred in 4 eyes（11. 8%） in group A,and 7eyes（17. 5%） in group B（χ2 =0. 478, P= 0. 533）. The kinds of intraocular filling materials were silicone oil instillation in 14 eyes （41. 2%）,expanding gas instillation in 4 eyes（11. 8%）,balanced salt solution in 16 eyes（47. 1%）in group A,and silicone oil instillation in 27 eyes （67. 5%）,expanding gas instillation in 4 eyes（10. 0%）,and balanced salt solution in 9 eyes（22. 2%）in group B（χ2 =5. 632,P=0. 060）. The vision of group A was better than that of group B（χ2 =8. 527, P=0. 014）. There was no difference at 3d and 2weeks after sugery between

关 键 词：糖尿病视网膜病变 增生性 玻切术 25 G+ 雷珠单抗 玻璃体内注射 术前 Vitrectomy 25 G + 

分 类 号：R779.6[医药卫生—眼科] R587.2[医药卫生—临床医学]